Psychopharmacology Training Program

The following description of the required courses and the content therein may be subject to changes necessitated by more current needs and/or other factors. The "content areas" listed below are the 10 knowledge-based segments included in the APA Psychopharmacology Examination for Psychologists (PEP)

I. NEUROSCIENCES: Didactic courses in the fields of neuroanatomy, neurophysiology, and neurochemistry are taught by faculty members with appropriate training and experience in these disciplines. Each course is 1.5 credit hours, and the course content is outlined below for each subject.

Neuroanatomy/Neuropathology:

Neuroanatomy:

Will include basic human neuroanatomy, with an emphasis on categorization of tracts by neurotransmitter systems. Categorization by neurotransmitter function will allow an early introduction to pharmacological agents and how they interact with the various anatomical pathways. The anatomy of the brain, spinal cord, and sympathetic and parasympathetic nervous systems will be important to the study of psychopharmacology. Brain regions studied will include cerebral cortex, frontal cortex, hippocampus, basal ganglia, thalamus and hypothalamus, brain stem (with particular attention to locus coeruleus and dorsal raphae nuclei). Involvement of particular anatomical regions in certain mental illnesses and relevant neurological illnesses will be introduced: Including appropriate items from APA Content Area 2

Content Area 2:Neuroscience

Refers to the anatomy, physiology, and biochemistry of the nervous system and its interfaces with other major body systems

Knowledge of the structure and function of nervous system cells

Knowledge of the structure and function of the central and peripheral nervous systems

Knowledge of the major neuronal pathways and their functions

Knowledge of the vascular supply of the brain, and the blood-brain and placental barriers

Neuropathology:

The neuropathology section will include cognitive, movement, developmental, and seizure disorders, chronic pain, traumatic brain injury, and other nervous system pathology. Basic neurodiagnostic markers of pathology and mechanisms of extrapyramidal and dysfunction will be included, as well as discussion of the hypothesized neuropathological basis of psychological disorders. Appropriate APA Content Areas will be included

Content Area 3: Nervous system pathology

Refers to disorders of the nervous system resulting in abnormal function or behavioral/mood disruption. Includes biochemical, structural (congenital or acquired), or neurophysiological abnormalities and their impact on other body systems.

Knowledge of etiological factors and diagnoses of dementia, delirium, and other cognitive disorders

Knowledge of etiological factors and diagnosis of chronic pain, including headache (e.g., differentiation of pain syndromes with primarily nervous, musculoskeletal, and tension-related etiology)

Knowledge of etiological factors and diagnosis of movement disorders (e.g., including Parkinson's, Huntington's, and Tourette's syndromes)

Knowledge of etiological factors and diagnosis of mental retardation

Knowledge of etiological factors and diagnosis of neurodevelopmental disorders (e.g., fetal alcohol syndrome, pervasive developmental disorders, Fragile-X syndrome)

Knowledge of etiological factors and diagnosis of central nervous system vascular disorders (e.g., cerebral vascular accidents [CVAs], transient ischemic attacks [TIAs])

Knowledge of etiological factors and diagnosis of seizure disorders

Knowledge of traumatic brain injury

Knowledge of other nervous system pathology (e.g., multiple sclerosis, infectious diseases, neoplasms)

Knowledge of neurobehavioral/psychological disorders that have an hypothesized neuropathological basis (e.g., schizophrenia, affective disorders, anxiety, ADHD)

Knowledge of basic neurodiagnostic markers of neurobehavioral disorders (e.g., as found on EEG and diagnostic imaging, and in neuropsychological assessment)

Knowledge of the mechanism of extrapyramidal dysfunction (e.g., dystonic reactions and tardive dyskinesia)

Neurophysiology:

Physiological concepts underlying central and peripheral nervous system function will be presented. Cellular neurophysiology concepts such as the resting potential, action potential and basic ion channel kinetics will be introduced. An integrated view of the electrical functioning of the brain, with an introduction to electroencephalographic concepts, will be introduced. Neurotransmitter receptor function, second messengers and neural plasticity with an introduction to cellular theories underlying learning will be included. Appropriate APA Content Areas be covered

Knowledge of cellular and molecular nervous system biology and regulatory processes and second messenger systems

Knowledge of the endocrine system and the interface of various hormones and other neurotransmitters

Knowledge of etiological factors and diagnosis of sleep disorders as related to the nervous system and psychopathology

Knowledge of basic neurodiagnostic markers of neurobehavioral disorders (e.g., as found on EEG and diagnostic imaging, and in neuropsychological assessment

Human Anatomy and Physiology:

This course introduces students to basic anatomy and physiology of normal cellular, tissue, organ and systemic levels of organization of the human body.   Material covered will be cellular function and physiology of organs and tissues, as well as the systemic functioning and anatomy of the immune and lymphatic organs, cardiovascular, respiratory, gastrointestinal, endocrine, hepatic and renal organs and systems.

 To gain a working knowledge of the basic cardiovascular system anatomy and physiology.

 To gain a working knowledge of the basic pulmonary system anatomy and physiology

 To gain a working knowledge of the basic renal/genitourinary system anatomy and physiology

 To gain a working knowledge of the basic hepatic system anatomy and physiology

 To gain a working knowledge of the basic endocrine system anatomy and physiology

 To gain a working knowledge of the basic hematological system anatomy and physiology

 To gain a working knowledge of the basic muscular/skeletal system anatomy and physiology

 To gain a working knowledge of the basic dermatologic system anatomy and physiology

 To gain a working knowledge of the basic immunologic/lymphatic system anatomy and physiology

Biochemistry:

This course will provide students with a brief review of those aspects of chemistry, organic chemistry and biochemistry which are needed for the study of pharmacology. For instance, in the field of general chemistry the instructor will review the general concepts of chemical compounds and bonds, and atomic theory. In the field of organic chemistry the instructor will review the concepts of organic compounds, bonds and valences. In the field of biochemistry the instructor will review biomolecules of proteins, carbohydrates, nucleic acids and lipids, as well as chromosomal theory and the genetic code, enzymes and metabolism. The assumption will be that all students have had previous coursework in chemistry, but that many students will have taken the courses many years previously. 

Professional, Ethical, and Legal Issues:

Informed consent as it relates to prescribing psychotropic medications will be emphasized, including issues of drug side effects such as tardive dyskinesia. Informed consent in drug research protocols. Confidentiality and compliance issues, including involvement of family members in informed consent and treatment sessions. Continuing education requirements. The difficult patient, including the chronically noncompliant patient will be addressed. Second opinions, limitations of practice by psychologists and situations in which referral to psychiatrists or other medical specialists are indicated. Clinical decisions to initiate inpatient versus outpatient treatment with medication. Electroconvulsive therapy, indications and legal/ethical considerations. This course will be approximately 0.5 credits. APA Content Area 10

Content Area 10: Professional, legal, ethical, and interprofessional issues

Refers to knowledge of ethics, standards of care, laws, and regulations relevant to the practice of psychology involving Psychopharmacology.

Knowledge of ethical codes and standards as they pertain to pharmacological practice and research (e.g., the APA Ethical Principles of Psychologists and Code of Conduct, APA Standards for Providers of Psychological Services, AERA/APA/NCME Standards for Educational and Psychological Testing, ASPPB Code of Conduct, Joint Commission on the Accreditation of Healthcare Organizations [JCAHO] Standards)

Knowledge of practice guidelines and standards of care for prescribing psychotropic medications (e.g., documentation requirements, nomenclature for writing prescriptions, written and verbal orders, elements of informed consent, patient education, institutional formulary restrictions, chemical restraints, Agency for Health Care Policy and Research [AHCPR] guidelines, National Institute of Mental Health [NIMH] consensus panel protocols, health care organization rules)

Knowledge of federal and state laws and statutes for prescribing psychotropic medication (e.g., FDA regulations, Medicare, controlled substance laws, specifics of psychologists' licensing laws, patient's rights)

Knowledge of issues involved in collaboration and consultation with other health care providers who are also prescribers and/or psychotherapists (e.g., "ownership' of patients, when to refer or seek consultation, differences in theoretical orientation, triangulation, appropriate levels of disclosure)

Knowledge of provision of psychotropic medications within specific environments (e.g., structured and unstructured environments, classroom and home, correctional institutions. military, substance abuse facilities)

Knowledge of patient's rights (e.g., informed consent, right to refuse treatment, right to treatment within the least restrictive environment, duty to warn, and privileged communication)

Knowledge of issues regarding relationships with pharmaceutical companies (e.g., acceptance of gifts, revealing sources of funding and affiliations)

Note: The complex of factors influencing human functioning noted in Content Area 1, i.e., biological (e.g. genetic, sex, age, disease), psychological (e.g., cognitive, emotional, dynamic, motivational, behavioral), psychosocial (e.g., gender, cultural/ethnicity, interpersonal), and ecological/environmental factors should be considered as they apply across all knowledge areas.

Neurochemistry :

This course will emphasize the various neurotransmitter systems relevant to modern psychopharmacological practice. These include but are not limited to: serotonin, norepinephrine, dopamine, acetylcholine, glutamate, GABA, opiods, and Substance P. The interaction of these neurotransmitters with their receptors will be emphasized, as will the mechanism of action of the various receptor systems. The biochemical mechanisms of action of prototypical drugs used in modern psychopharmacological practice will be introduced in this course.

Knowledge of major neurotransmitter and neuromodulator synthesis, storage, release, distribution throughout the brain and the rest of the body, action, reuptake, and degradation

Knowledge of neuropeptides (e.g., enkephalin, endorphin, substance P)

II. CLINICAL AND RESEARCH PHARMACOLOGY AND PSYCHOPHARMACOLOGY:

Approximately ten credit hours will be devoted to courses in general pharmacology, psychopharmacology, developmental psychopharmacology, and chemical dependency and pain management, as outlined below. In addition, review of the general principals involved in the conduct of research on psychoactive substances as itemized in APA Content Area 9

Content Area 9: Research

Refers to the methodology, standards, and conduct of research on psychoactive substances. The knowledge base facilitates research design and implementation, accurate data interpretation and communication, effective utilization of findings, the accumulation of scientific knowledge, and the improvement of the practice of clinical psychopharmacology.

General Pharmacology:

This core course_, consisting of approximately four credit hours, will cover basic science and clinical concepts fundamental to the subject of general pharmacology. This will be presented to introduce genera! principles (such as pharmacodynamics and pharmacokinetics) which will be expanded upon in the psychopharmacology courses, and to provide students with knowledge of general pharmacological agents used in general medical practice. This will introduce the important concept of drug interactions, which will be reemphasized throughout later course work. General principles including routes of administration, half-life, protein-binding, lipid solubility and the blood-brain barrier will be included. General pharmacology principles will include drugs such as antibiotics, cardiovascular agents, analgesics and drugs affecting the renal, pulmonary, gastrointestinal, and urological systems. Drug interactions will be emphasized in each section. Developmental pharmacology will be covered with special emphasis on pharmacokinetic and pharmacodynamic differences in the very young and very old patients. APA Content Area 7 will be covered

Content Area 7:Pharmacology

Refers to the interactions of drugs with biophysiological systems; encompasses pharmacokinetics, pharmacodynamics, pharmacogenetics, and the epidemiology of various medications such as psychotropics, adjunctive agents, and other medications used in the practice of medicine, as well as substances of abuse, OTC products, and food and dietary supplements. The influence of cultural/ethnic factors, environmental factors, and responses of special populations are considered.

Knowledge of drug classifications for psychotropic and adjunctive medications (e.g., stimulants, sedatives, antidepressants, anticholinergics), other drugs used in the practice of medicine, OTC medications, and substances of abuse

Knowledge of biological factors effecting pharmacokinetics and pharmacodynamics

Knowledge of absorption (e.g., delayed-release preparations, rates of absorption after oral dosing or parenteral injection, area under the curve, timing with food intake)

Knowledge of distribution (e.g., plasma protein binding, influence of lipophilicity)

Knowledge of metabolism (e.g., drug metabolism, understanding of the substrate and inhibitors and inducers of the "family" of P450 enzymes, other enzymes outside the liver)

Knowledge of excretion (e.g., renal filtration rate, clearance of drugs)

Knowledge of importance of biological half-life in determining steady-state drug concentrations, dosing schedules, accumulation

Knowledge of drug properties and characteristics (e.g., therapeutic index, therapeutic blood levels/prescription doses, potency, bioavailability, efficacy, cognitive and behavioral manifestations of toxicity, dose-response relationships)

Knowledge of types of drugs and other agents interacting with receptors(e.g., direct and redirect agonists, antagonists, and inverse agonists)

Knowledge of drug-induced cellular adaptation (e.g., cellular signaling ion channels, second messengers, neurotransmitter release, sensitivity, supersensitivity)

Knowledge of drug effects on genetic expression (e.g., down-regulation)

Knowledge of specific neurotransmitters, receptors, modulators, and neuropeptides

Knowledge of mechanisms of action of a range of therapeutic agents with particular focus on psychotropic and adjunctive medications

Knowledge of theoretical relationships thought to exist between neurotransmitter systems and psychopathological conditions based on known mechanisms of action and clinical observations (e. g., roles of serotonin in depression, dopamine in psychosis and substance abuse)

Knowledge of drug-drug and drug-food interactions for a range of medications as well as substances of abuse, and supplements and other OTC products

Knowledge of drug-induced disease, dysfunction, and adverse reactions (e.g., hepatotoxicity, agranulocytosis, dystonias)

Knowledge of genetic polymorphisms (e.g., ethnic and gender differences, differences in cytochrome P450 isoenzymes in drug metabolism)

Knowledge of familial patterns of drug response and toxicity

Knowledge of pharmacoepidemiology (e.g., epidemiology of psychotropic drug use)

Knowledge of tolerance, dependence, and withdrawal

Knowledge of the FDA drug development process (i.e., Phase I: Human Pharmacology; Phase Il: Therapeutic Exploratory; Phase III: Therapeutic Confirmatory; Phase IV: Therapeutic use)

Knowledge of current status of research regarding specific medications

General Psychopharmacology:

This four credit core course will cover the general principles underlying the use in modern practice of drugs to treat the major classes of mental illness. This will include antipsychotics (conventional and atypical), antidepressants, anxiolytics, mood stabilizers, and special topics. Mechanism of action, drug interactions, pertinent aspects of differential diagnosis will be discussed. Psychiatric aspects of general medical conditions, with particular attention to the diagnosis and treatment of delirium will be presented. APA Content Area 8 will be covered.

Content Area 8: General Psychopharmacology

Refers to the application of pharmacology to the management of psychological/behavioral disorders. This includes indications, contraindications, dosing, adverse effects and toxicities of psychotropic and adjunctive medications, interactions with other medications (including other drugs used in medicine, for recreational purposes, and available for OTC purchase) as well as the management of adverse reactions, overdoses, and toxicities.

Knowledge of indications, contraindications, and off-label uses of various psychotropic and adjunctive medications

Knowledge of rational for psychotropic medication selection, taking into account target symptoms, patient and family history premorbid personality, demographics, comorbid medical conditions, existing medication regimen and potential for interactions, and differences among medications within classes off drugs

Knowledge of dosing, time course of therapeutic action and adverse effects; and patient factors that influence dose (e.g., weight, gender, ethnicity, age, concurrent disease)

Knowledge of therapeutic monitoring, augmentation strategies, and dose adjustment (e.g., titration, cross-taper, discontinuation)

Knowledge of routes of administration (e.g., oral, intramuscular, intravenous, inhalation) and differential response

Knowledge of specific drug toxicities, management of adverse reactions, including overdose, and indications for referral for appropriate medical care (e.g., acute allergic reaction, extrapyramidal symptoms, hypertensive crisis)

Knowledge of interactions of psychotropic and adjunctive medications with other medications (including other drugs used in medicine, for recreational purposes, and available for OTC purchase)

Knowledge of relapse prevention, maintenance, and prophylaxis (e.g., strategies for sustaining remission of substance abuse, ensuring treatment compliance, preventing recurrence of depression)

Knowledge of drug effects in special populations e.g., developmentally disabled, elderly, pregnant or lactating women)

Knowledge of pharmacological implications for comorbidity of age-related and disability-related disorders (e.g., overanxious disorder comorbid with ADHD)

Knowledge of potential psychological and physiological manifestations of (medications including OTC drugs, supplements, and herbal substances) used for nonpsychological purposes (e.g., beta blockers, steroids)

Knowledge of psychological and physiological manifestations of various recreational substances and treatment of intoxication or addiction, including strategies for assisted withdrawal, maintenance, and relapse prevention.

Knowledge of tolerance, cross tolerance, dependence and withdrawal, sensitization/cross-sensitization with respect to specific medications, and the management strategies used to treat them.

Knowledge of drug-seeking behavior, and potential for abuse of prescription medications.

Knowledge of culturally appropriate educational techniques to inform patients about drug utilization, risks, benefits, potential complications, and alternatives to pharmacotherapy (e.g., procedures to enhance compliance, techniques to teach appropriate attribution and self-monitoring).

Developmental Psychopharmacology:

This 1.5 credit course will supplement the general psychopharmacology course by emphasizing the treatment of disorders of childhood and old age. Disorders in children will include ADHD, anxiety disorders, depression, and others. Differences between the treatment of these disorders in children and adults will be pointed out. Treatment of comorbid conditions in children with conduct disorder, mental retardation, and learning disabilities will be discussed. In the geriatric population, treatment of dementia and delirium will be emphasized. Common medical conditions presenting with psychiatric manifestations, and the treatment of depression, psychosis, anxiety, and insomnia in the elderly will be topics of discussion. Again, drug interactions will be emphasized.

Chemical Dependency and Pain Management:

Substance abuse and its treatment will be discussed in this 1.5 credit course. Major classes of substances of abuse, including alcohol, cocaine, marijuana, opiates, hallucinogens, stimulants, caffeine, and nicotine will be discussed. Diagnosis, evaluation and treatment of intoxication and withdrawal states will be emphasized. Abuse of commonly prescribed psychotropics and drugs used to treat pain will be topics for discussion. The treatment of chronic pain with opiates, antidepressants, mood stabilizers, and other adjunctive treatments will be discussed

III. PATHOPHYSIOLOGY:

This section consists of one four credit core course, which covers the following topics fundamental to modern pharmacological practice: The disorders of physiology and pathophysiology (disease states) of the various organ systems of the human body (cardiovascular. renal, endocrine, gastrointestinal, urological, sex organs, organs of special senses, musculoskeletal.) Psychological manifestations of general medical conditions will be emphasized. Interactions of drugs used to treat general medical conditions with those commonly used in psychopharmacological practice will be discussed. Effects of general medical conditions on drug pharmacokinetics and pharmacodynamics as well as effects of age, sex, and ethnicity will be discussed. This section will include APA Content Area 4

Content Area 4: Physiology and Pathophysiology

Refers to the disorders of physiology and pathophysiology across the life span, and to their impact on psychological functioning and psychopharmacology.

Knowledge of indications for referral to other health care providers for treatment or additional assessment

Knowledge of basic cardiovascular system physiology and pathophysiology across the life span (e.g., rhythm and rate disorders such as prolonged QT interval)

Knowledge of interrelationships between cardiovascular functioning and: psychopharmacology (e.g., EKG changes secondary to TCAs, blood pressure changes secondary to psychotropics, beta blockers, and depression), and psychopathology (e.g., mitral valve prolapse related to panic disorder, tachycardia related to generalized anxiety disorder)

Knowledge of basic pulmonary system physiology and pathophysiology across the life span

Knowledge of interrelationships between pulmonary functioning and psychopharmacology (e.g., theophylline and anxiety, beta blockers and asthma), and psychopathology (e.g., hypoxia versus dementia)

Knowledge of basic renal/genitourinary system physiology and pathophysiology across the life span (e.g., effect of electrolyte imbalance on mental status)

Knowledge of interrelationships between renal/genitourinary functioning and (a) psychopharmacology (e.g., effect of psychotropic substances on urinary/sexual functioning), and (b) psychopathology (e.g., urinary tract infection and mental status change in the elderly)

Knowledge of basic hepatic system physiology and pathophysiology across the life span (e.g., first-pass metabolism, disorders affecting first-pass metabolism)

Knowledge of interrelationships between hepatic functioning and (a) psychopharmacology (e.g., the interaction between psychotropics and liver enzymes, such as the cytochrome P450 system), and b) psychopathology (e.g., metabolic encephalopathy and delirium; carcinoid tumor and anxiety)

Knowledge of basic endocrine system physiology and pathophysiology across the life span (e.g., relationship between thyroid function tests and hypothyroidism and hyperthyroidism)

Knowledge of interrelationships between endocrine functioning and (a) psychopharmacology (e.g., elevated prolactin and antipsychotic medications), and b) psychopathology {e.g., hormonal disequilibrium and perimenstrual dysphoria, depression and Cushing's disease)

Knowledge of basic hematological system physiology and pathophysiology across the life span

Knowledge of interrelationships between hematological functioning and psychopharmacology (e.g., agranulocytosis and clozapine, thrombocytopenia and carbamazepine), and psychopathology (e.g., anemia and depression) 0414 Knowledge of basic muscular/skeletal/dermatologic system physiology and pathophysiology across the life span (e.g., hypercalcemia and depression)

Knowledge of interrelationships between muscular/skeletal/dermatologic functioning and psychopharmacology (e.g., alopecia and valproic acid), and psychopathology(e.g., OCD and trichotillomania)

Knowledge of basic immunologic/rheumatology system physiology and pathophysiology across the life span (e.g., systemic lupus erythematosus (SLE).

Knowledge of interrelationships between immunologic/rheumatologic functioning and (a) psychopharmacology, and b) psychopathology (e.g., SLE and depression, fibromyalgia and depression, AIDS-related dementia)

Knowledge of interface of psychological, physiological, and behavioral factors and their relationship in complex behaviors and processes involving multiple body systems (e.g., psychoneuroimmunology, sexual functioning)

Knowledge of relationship of complex behaviors involving multiple body systems with (a) psychopharmacology (e.g., sleep disruption secondary to antidepressant medication), and (b) psychopathology (e.g., sexual dysfunction and depression)

IV. INTRODUCTION TO PHYSICAL ASSESSMENT, LABORATORY EXAMS and DIFFERENTIAL DIAGNOSIS

This three credit course will introduce the topics of basic history and physical examination, as they are pertinent to prescribing of medication. The goal of this course will be to allow the practitioner to gain the knowledge necessary to interpret reports of medical histories, physical examinations, and laboratory studies. Laboratory studies will include basic blood chemistry panels, complete blood counts, thyroid and other endocrinological tests, urinalyses, basic radiological studies computed tomography scans, magnetic resonance imaging studies of the brain, electrocardiogram reports, and electroencephalogram reports. The monitoring of psychotropic medications with blood levels where appropriate and required concomitant general laboratory tests (e.g.: liver function tests with Depakote, thyroid function tests with lithium, etc.) will be emphasized. The ability to distinguish between side effects of medication versus signs and symptoms of general medical conditions, as they are manifested in the history, physical exam, and laboratory studies, will be emphasized also. This area will include APA Content Area 5 and Content Area 6

Content Area 5: Biopsychosocial and Pharmacological Assessment and Monitoring

Refers to a range of biopsychosocial (psychological, neurological, behavioral, physical, biomedical) and pharmacological assessment techniques and procedures for baseline and ongoing evaluation of the individual's physical and psychological health status as well as the assessment of therapeutic efficacy, adverse effects, contraindications for usage, drug interactions, and appropriateness for medication continuation, modification, or discontinuation.

Knowledge of psychological assessment and history taking procedures (e.g., comprehensive individual and family mental health history, dietary habits, mental status, and behavioral assessments)

Knowledge of basic physical and neurological examination procedures

Knowledge of normal laboratory values in screening, assessment, and monitoring techniques, and the implication of disease states, sample timing, and medications on those values

Knowledge of laboratory tests and assessment procedures indicated for general assessment (e.g., basic screening panel), appropriate for use with special populations (e.g., females, individuals experiencing first psychotic break), or before prescribing particular medications (e.g., lithium)

Knowledge of medication-specific therapeutic drug monitoring, and indications for monitoring of clinical laboratory values (e.g., TCA levels, renal functioning in lithium use)

Knowledge of behavioral assessment methods (e.g., rating scales, direct observation of behaviors, parent/teacher/self report) in baseline and ongoing monitoring of therapeutic effectiveness, quality of life, and adverse effects of psychopharmacological agents (e.g., tardive dyskinesia with antipsychotics, sexual dysfunction with antidepressants)

Knowledge of techniques for differential diagnosis and indications for referral to other health care providers based on identification by abnormal biopsychosocial or pharmacological evaluation measures

Knowledge of intellectual and neuropsychological assessment as it pertains to aiding diagnosis (e.g., depression versus dementia), indications for medication regimens, and ability to provide informed consent

Content Area 6: Differential Diagnosis

Refers to the use of comprehensive diagnostic information about a patient to establish an accurate diagnosis from among possible medical and psychological diagnoses in order to select appropriate treatment modalities and determine appropriateness of referral to other heath care providers.

Knowledge of medical disorders that present as psychological disorders (e.g., ADHD versus PKU versus autism, anxiety versus Graves' disorder)

Knowledge of psychological disorders that present as medical disorders (e.g., factitious disorders, somatization disorders)

Knowledge of psychological signs and symptoms (e.g., mental status changes, memory dysfunction, depression, psychosis) secondary to substances of abuse, prescribed and over-the-counter [OTC] medications, supplements, and alternative treatments (e.g., St. John's Wort, steroids)

Knowledge of varied presentations of psychological disorders in different populations (e.g., depression versus dementia in the elderly, ADHD versus anxiety in children, mania versus paranoid schizophrenia in African Americans)

Knowledge of the use of psychological testing, physical and laboratory assessment, and medication response to clarify diagnostic dilemmas (e.g., mania versus cocaine abuse versus hyperthyroidism versus theophylline overdose)

Knowledge of psychopharmacological implications for mental health disorders with overlapping symptomatology (e.g., major depressive disorder with psychotic features, anxious depression)

Knowledge of dual diagnosis and co-morbid conditions (e.g., double depression, alcoholism and schizophrenia, depression with Parkinson's disease)

Knowledge of iatrogenic effects of medication versus primary symptoms of disease progression (e.g., akathisia versus anxiety; depression versus negative symptoms of schizophrenia; anticholinergic reactions versus dementia; medication-induced tremor, dystonic reaction, or tardive dyskinesia versus primary movement disorders)

V. SPECIAL ISSUES IN PHARMACOTHERAPEUTICS:

Psychotherapy/Pharmacotherapy Interactions:

This one credit course will examine the single practitioner model, in which one practitioner provides therapy and medication prescription services, versus a split treatment model in which these functions are divided among two practitioners. Literature studies of synergistic interactions between psychotherapy and pharmacotherapy will be introduced. Will include APA Content Area 1

Content Area 1: Integrating clinical psychopharmacology with the practice of psychology

Refers to the implementation of clinical practices of biopsychosocial assessment, multiaxial diagnosis, and treatment, including pharmacotherapy, in the context of a complex of factors influencing functioning. These factors include biological (e.g., generic, sex, age, disease), psychological (e.g., cognitive, emotional, dynamic, motivational, behavioral), psychosocial (e.g., gender, cultural/ethnic, interpersonal), and ecological/environmental factors.

Knowledge of biopsychosocial variables as determinants of medication effects (e.g., family history, differential familial medication response, patient belief systems, economics, social support, current environmental circumstances)

Knowledge of relative effects of psychopharmacological and psychological interventions as sole, additive, or interactive treatment, for given disorders

Knowledge of limitations and value of single-treatment modalities, combined interventions (i.e., medication employed alone or in conjunction with a psychological therapy), and patient perceptions (e.g., attributions of therapeutic and adverse psychological meaning of medication, motivations, treatment expectations)

Knowledge of timing and sequencing of interventions to achieve maximum treatment effectiveness, including importance of patient instruction

Knowledge of practitioner-patient relationship, including its impact on medication adherence, efficacy, adverse effects, and response to side effects, and implications for the relationship when physical and pharmacological interventions are utilized

Knowledge of the development and implementation of a coherent and organized treatment plan of psychological and pharmacological intervention

Knowledge of case and medication management techniques to enhance adherence to treatment plan (e.g., biological and psychological principles relevant to adherence, communication skills, patient education techniques, cultural competence)

Knowledge of pharmacoeconomics/cost issues in treatment planning

Computer Based Practice Aids:

Use of computer databases such as Medline literature searches will be introduced. On-line resources such as the National Library of Medicine database and drug interaction databases will be introduced. Computer networks used to receive laboratory and radiology reports, and to communicate with pharmacies will be covered. This course will consist of one-half credit hour.

Pharmacoepidemiology/Literature Review and Critique:

This one credit hour course will examine the literature relating to treatment of various disorders with psychotropic medication: for example, the literature on maintenance and discontinuation of antidepressant medication. Literature studies of abuse of prescribed and illicit drugs will be included. Attention to research protocols will be emphasized.

Knowledge of psychopharmacological retrieval systems and databases

Knowledge of research designs and analytic techniques used in psychopharmacological research (e.g._, double-blind, drug washout, control groups, dose-response relationships, intent-to-treat analyses, endpoint analyses, within-subject and group designs, cross-over, use of "rescue" medications, and concurrent administration of other drugs [including OTC, and nonpsychotropic medications])

Knowledge of measurement issues in psychopharmacological research (e.g., sample heterogeneity; sample size; random assignment of participants to treatment conditions; drug levels; outcome measures; standard monitoring procedures for side effects, adverse effects, and drug levels; interpretation issues; and interobserver reliability)

Knowledge of community and participatory research strategies to enhance the relevance of studies on ethnic/cultural and other undeserved populations (e.g., use of community advisory boards, community involvement in research planning)

Knowledge of regulatory issues in psychopharmacological research (e.g., FDA regulations, informed consent, research ethics, Institutional Review Board [IRB], safety, abuse liability, follow-up, compassionate care)

Knowledge of how to critically review clinical research data and use the information for making treatment decisions.